Implementing Substance Use Care Across Care Settings: ED to Ongoing Care

In this episode of ASAM Practice Pearls, Dr. Stephen Taylor hosts Dr. Sarah Wakeman to discuss substance use care in the emergency department, sharing highlights from ASAM's new implementation guide for hospital and emergency department (ED) substance use disorder (SUD) care. Together, they explore the gap between evidence-based addiction treatment and current hospital/ED practice, how frontline non-specialist clinicians can provide effective SUD care, practical implementation models, and how to build seamless care transitions from the ED to ongoing treatment. ----more---- Looking for this episode's transcript? Download it HERE Get credit for listening! Claim your 0.5 CEs HERE Have an idea for a future episode? Share it with us at education@asam.org. Host Stephen M. Taylor, MD, MPH, DFAPA, DFASAM Dr. Stephen M. Taylor is ASAM's President and is board certified in general psychiatry, child and adolescent psychiatry, addiction psychiatry, and addiction medicine. With over 30 years of practice experience, Dr. Taylor is dedicated to helping adolescents and adults overcome addiction and co-occurring psychiatric disorders. He has served as the Medical Director of the NBA and NBPA Player Assistance and Anti-Drug Program for 16 years and is the Chief Medical Officer of Pathway Healthcare, which operates multiple outpatient addiction and mental health treatment offices across six states. Expert Sarah Wakeman, MD, FASAM Dr. Sarah Wakeman is the Senior Medical Director for Substance Use Disorder at Mass General Brigham, Director of the Mass General Brigham Program for Substance Use and Addiction Services, and an Associate Professor of Medicine at Harvard Medical School. She received her AB from Brown University and her MD from Brown Medical School. She completed residency training in internal medicine and served as Chief Medical Resident at Mass General Hospital. She is a diplomate of the American Board of Addiction Medicine and board certified in Addiction Medicine. Clinically, she provides specialty addiction and general medical care in the inpatient and outpatient setting at Mass General Hospital and the Mass General Charlestown Health Center. Her research focuses on the integration of addiction care into general medical settings and opioid use disorder treatment. 📖 Show Segments 00:05 - Introduction  02:57 - The Gap in ED and Hospital Addiction Care  05:50 - Setting Realistic Expectations for Frontline Clinicians 08:19 - Critical Elements of Care for Non-specialists 12:07 - Implementation Systems 17:15 - Effective Transitions of Care 21:48 - Closing the Feedback Loop: Sharing Success Stories 24:37 - Practice Pearls 26:23 - Conclusion and Additional Learning Opportunity  📋 Key Takeaways Treat the underlying disorder, not just the acute presentation: While effective treatments for SUDs have existed for decades, many emergency departments and hospitals still don’t consistently deliver evidence-based addiction care during admission, often only treating the complications without addressing the underlying condition. Addiction care should be the standard, not the exception: Initiating medications (e.g., buprenorphine, methadone, naltrexone), managing withdrawal, and linking patients to care should be an expectation for all frontline clinicians. Consider the seven core competencies as your quality checklist for SUD care: Screening, withdrawal management, overdose response, medication initiation, co-occurring conditions, linkage to care, and risk reduction should all be addressed for every SUD patient. Systems change can start small and scale: Even without large resources, hospitals can enhance care through clinical pathways, order sets, education, and peer champions, making best practices easier to implement in everyday workflows. Having a peer champion can help implement these practices by normalizing the behavior, providing real-time support, and making the change feel achievable. Think of system change like motivational interviewing: Approaching the system and framing addiction care in terms the institution already cares about and is familiar with can help make change. Provide warm handoffs and follow-up: The highest-risk period is the first week post-dis